Transitions of care between the inpatient ward and outpatient primary care setting are an essential process in ensuring quality patient care. One of the most important aspects of this process is communication between the discharging and accepting physician upon discharge. The quality of this communication is heavily dependent on the discharge summary, as often this is the principal method of explaining the patient’s hospital course to the outpatient physician.
The process of preparing a discharge summary, especially the hospital course portion, is often variable, and among residency training programs there exists variation in the amount of formal training of housestaff on how to write discharge summaries. Furthermore, there is a paucity of literature assessing which elements of the discharge summary are most important from the outpatient primary care perspective, and how to integrate these elements into the process of discharging patients.
The object of our program intervention is to conduct a quality improvement study which objectively assesses discharge summaries written by housestaff, identify which elements are most important from the primary care perspective, and implement an intervention which incorporates these essential discharge summary elements into a standardized template which serves as the residency program guidelines for writing discharge summaries.
We first conducted a literature search on discharge summary quality. We then extrapolated several key factors for quality discharge summaries that were consistently identified across multiple studies. We then interviewed the users of the current discharge summaries at our institution to find out which quality metrics were already met and which were unmet. As our intervention, we created a structured template that contained the elements of the discharge summary that were identified as important by literature review and our initial survey. During a single inpatient month, three of six ward teams were assigned to use this template for discharge summaries. The remaining three teams continued with usual practice. The patients discharged from each team were recorded and their discharge summaries collected for analysis. The evaluations of the primary care physicians in the study were collected and assigned numerical scores based on their answers chosen. These numerical scores were compared statistically for the pre‐intervention and post‐intervention phases of the study using two‐tailed z‐tests.
Significant improvements were made in several key areas of the discharge summary. Our intervention led to more concise “History of Present Illness” dictations (p<0.05), provided more essential information than the controls (p<0.05), was overall shorter in length (p<0.05), and had a more visually appealing layout (p<0.05) which made for easier readability in the clinic setting.
Communication in a concise and clear manner is important to ensure continuity of care between the inpatient and outpatient setting. Implementing a standardized procedure of any scale or scope is a valuable tool in quality improvement in a complicated process such as discharging patients from the hospital.
To cite this abstract:Amin A, Kaushal N, Rochon‐Duck M, Qazi M, Cho M, Hyunh R. Transitions of Care Between Inpatient and Outpatient Setting: The Role of the Discharge Summary and the Discharge Process. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 98. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/transitions-of-care-between-inpatient-and-outpatient-setting-the-role-of-the-discharge-summary-and-the-discharge-process/. Accessed April 4, 2020.